This is a Shannon Award providing partial support for research projects that fall short of the assigned institute's funding range but are in the margin of excellence. The Shannon award is intended to provide support to test the feasibility of the approach; develop further tests and refine research techniques; perform secondary analysis of available data sets; or conduct discrete projects that can demonstrate the PI's research capabilities or lend additional weight to an already meritorious application. The abstract below is taken from the original document submitted by the principal investigator. The purposes of this study are to: (1) identify differences in biologic and behavioral outcomes among healthy individuals and adequately nourished and undernourished persons with chronic airflow limitation (CAL) and (2) evaluate the effects of nutritional supplementation on biologic and behavioral health outcomes in CAL. Several aspects of undernutrition associated with CAL have not been fully explored including the exact mechanism leading to weight loss, the type of intervention most suitable for persons with CAL, and behavioral outcomes of nutritional support. Thus, there is no standard of care for undernourished persons with CAL. Since the CAL itself is irreversible and the longevity can be 18-20 years post-diagnosis, it is critical that any reversible co- existing conditions be identified. Two sequential studies are planned to increase understanding of both biologic and behavioral aspects of CAL. The specific aims of this project are to: (1) determine the prevalence of increased metabolic rate in undernourished persons with CAL; (2) assess the prevalence of increased skeletal muscle breakdown in undernourished persons with CAL; (3) evaluate the relationship between altered metabolic conditions and behavioral outcomes for persons with CAL; (4) test the efficacy of 12 weeks of nutritional supplementation on biologic outcomes (e.g., nutritional status and pulmonary function) and behavioral outcomes (e.g., exercise tolerance, self-reports of resting and exercise dyspnea, disease-specific functional status, and quality of life); and (5) identify differences in metabolic parameters, exercise tolerance, and dyspnea induced by carbohydrate-based versus fat-based supplements. The first phase is a cross-sectional three-group comparative study to compare nutritional status, energy expenditure, disease-specific functional status, and quality of life in undernourished subjects with CAL, adequately nourished subjects with CAL, and healthy persons. The second study is a randomized controlled trial using a three-group experimental design. Undernourished persons with CAL will receive one of three nutritional supplements: (1) placebo; (2) fat-based supplement; or (3) carbohydrate-based supplement. Two types of comparisons will be made: (1) the benefit of supplementation over placebo; and (2) the benefit of the fat-based supplement over the carbohydrate-based supplement. Little attention has been given to the improvement of both biologic and behavioral health status through nutritional support for individuals with CAL. Findings of these studies will have clinical implications for nursing care of undernourished CAL patients.